The topic I chose for my research paper is Conduct Disorder.
I chose this topic because I have come in contact with several children and adolescents in my family, children of my friends and coworkers that have been diagnosed with this disorder. I want to gain a better understanding of this disorder and the effective treatment approaches. By doing my research paper on “Conduct Disorder” I will gain this knowledge.
Also, I want to understand the Conduct Disorder diagnostics criteria in depth, “DSM-IV emphasizes that there should be at least three specific conduct disorder behaviors present for at least six months to make the diagnosis” (Searight, Rottnek & Abby , 2001) and how this disorder is treated as well as what are the affects if it’s not treated.
A lingering question for me that will be answered during my research is what happens to the children that have this disorder when they become adults?
What makes Conduct Disorder unique from what my classmates intend to write about?
Several of the disorders picked by my classmates are commonly discussed disorders, i.e. Obsessive Compulsive Disorder (OCD), Bipolar Disorder, Gender Identity Disorder, Alzheimer’s (Dementia), Bulimia and Panic Disorder.
Whenever there is a behavior issue with a child, the first thing that usually comes to mind is that the child has ADHD. There are very few people that are aware of Conduct Disorder and it’s one of the most diagnosed psychiatric problem, “Conduct disorder has become a major health and social problem; it is the most common psychiatric problem diagnosed among children”, (Stacey, 2008).
Conduct Disorder is also unique in that “it is severe and highly disruptive to the person’s life and to others in his/her life. It is also very challenging to treat” (Center for Disease Control and Prevention, 2010). Conduct Disorder has been identified as been linked to Anti-social Disorder in adults.
In closing, majority of the children with Conduct Disorder often end up incarcerated. They are unable to maintain positive relationships with peers, parents or teachers. By doing my research paper on Conduct Behavior, I hope to educate myself and classmates to be able to not only recognize this disorder but to inform others of the symptoms and affects.
The disorder is known to have a 10% prevalence rate in the general population. The etiology consists of hereditary and environmental issues.
Conduct disorder is categorized as a major externalizing disorder which can have severe effects on a child’s life. If left undiagnosed the child is simply left as being labeled as a ‘problem child’ which further has worsens the child’s situation as it will then be treated accordingly in society. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV-TR) puts forward the knowledge of an increasing trend of statistical numbers regarding the disorder throughout the last few decades with some studies suggesting prevalence rates as high as 10% in the general population. (Mauro, 2010)
The DSM IV has set the diagnostic criteria of the disorder to include behavior patterns that are recurrent and persistent and violate the basic rights of other fellow human beings or conventional social norms. These behavior patterns should include three or more of the symptomatic acts persisting through twelve months and at any rate one of them in the previous six months. These include aggression towards other living beings, for example, bullying, starting physical fights, physically cruel acts towards either people or animals, or even forcing another into sexual activity. They may also exhibit destructive behaviors including destroying property, setting fires, etc. There may also be dishonesty in acts or theft, for example, breaking another’s boundaries by entering their house or car without permission or even shop lifting. The child may seriously violate rules, such as, by remaining outside at night before allowed to do so in defiance of parental rules and even truancy before age 13. The child may show noteworthy lacking of skills where social, academic, or occupational functioning is required. Also, if the person is older than 18 and the criteria is not fulfilled for antisocial personality disorder then the problem may still be categorized as conduct disorder. (Davison, Neale, & Kring, 2003)
The etiology of conduct disorder includes an involvement of genetic, family related and social factors interacting. Decreased baseline autonomic nervous system activity may be inherited by the child, which requires greater stimulation to achieve most favorable level of arousal. This genetic factor may be responsible for the extreme levels of sensation-seeking activity which is connected with conduct disorder. Contemporary studies center on highlighting neurotransmitters that play a part in aggression, with serotonin kept in sight as highly important in the process as well.
Domestic problems play a major role in increasing the threat of conduct disorder. Included in this are substance abuse by parents, psychological illnesses, conflict between the caregivers, and child neglect and abuse. Being exposed to the antisocial behavior patterns of a caregiver is a highly important factor of risk. Interestingly, children who have this disorder although being present in all socioeconomic strata, seem to have the highest number in lower socioeconomic levels. Discipline and parental availability appear to be another highly common factor. Thus, children who have conduct are not taught to experience the consequences of their behavior.
The childhood pattern is inclusive of irritability, inconsolability and impaired social responsiveness. Inconsistence and coercion may become a part of the child’s life with caregivers who have psychiatric illnesses or drug abuse problems. Further worsening the problem, the included families often go through financial distress. Peer group influence, which characteristically increases some time in elementary school also effects these children more as they are more vulnerable to it. (Searight, Rottnek, & Abby, 2001)
Turning to the prognosis of the disorder, possibly about 30% of children with the disorder continue on facing similar issues in adulthood. However, males have a higher rate of continuing on into adulthood with the problems conduct disorder provides than females do. Females with the disorder are more at risk to facing problems connected with affective and anxiety disorders as they grow older. Statistics show that around 50-70% of kids who are ten years of age with conduct disorder are highly likely to be abusing substances in later years. There are also high correlations with cigarette smoking. Studies also show that females with conduct disorder are likely to have poorer physical health than normal. Accordingly, studies show that girls with conduct disorder were almost six times more at risk to be drug or alcohol abusers, eight times more likely to be addicted to cigarettes, were almost twice as likely to be at risk for having contracted sexually transmitted diseases, had double the amount of sexual partners, and were three times as likely to turn out to be pregnant when compared to females who did not have the disorder.
On the other hand, when they grow into being adults, 70% of children stop showing signs of conduct disorder. However, apart from a few they are not well. This is as although conduct disorder signs do not appear to be problematic, comorbid problems do not leave and they may even get worse. For example, a girl with conduct disorder and affective disorder may end up as an adult with affective disorder, but no conduct disorder. The same can be seen with other comorbid disorders. (Chandler, 2002)
For all people diagnosed with conduct disorder, co-occurrence with ADHD appears to be 50% minimum. Although differentiating between conduct and attentional disorders may be achievable, it does not seem to be practically beneficial to do so as use may be limited. This is as these disorders are highly correlated, especially in younger children.
There are high comorbidity rates connecting externalizing disorders and a significant amount of internalizing disorders, for example, anxiety and affective disorders. Comorbidity of 32-37% is indicated in cross-sectional studies of individuals with the disorder. Again, the lacking parenting style of a psychologically ill parent can be a contributing factor to the development of conduct disorder in a child who fails to later in life develop antisocial personality disorder. (Tynan, 2010)
During differential diagnosis, one may have to eliminate the possibility of a similar disorder being the problem. The disorders one may come across include oppositional defiant disorder, attention-deficit/hyperactivity disorder, substance abuse/dependence, major depression and dysthymic disorder, bipolar mood disorder, and intermittent explosive disorder. (Searight, Rottnek, & Abby, 2001)
Cross-cultural studies have been conducted in order to determine differences and similarities. Broad reviews of the text on the growth of conduct problems put forward that occurrence and frequency is greatest among people within the United States. On the other hand, a number of longitudinal studies carried out in other countries have been essential to the expansion of theory, for example, in London, Finland, Norway, New Zealand, and Sweden. Even though prevalence may vary, the most important theories of etiology, clustering of symptoms, constancy, and longtime course over the duration of existence show a high level of similarity across international circumstances. (Net Industries, 2010)
The learning theory may be applied when seeking to treat conduct disorder, which is a part of behavior therapy. The basic design consists of having the child unlearn inappropriate behaviors as the theory suggests that behavior patterns are in a large part learned from exposure to rewards and punishments. Thus unwanted behaviors can be removed and instead pro-social behaviors can be taught through systematic manipulation of consequences and rewards that encourage wanted behavior and discourage unwanted behavior.
Behavioral strategies applied when treating conduct disorder focus on minimizing blame as parents often incorrectly place blame upon their children for the situation as well as upon themselves, also increasing the amount of time parents spend supervising their children, and on introducing behavioral contracting. This involves the drawing up of a contract between the parent and the child which is an agreement to minimizing behaviors which are unpleasant to both party and agreeing on punishments and rewards. This ensures the avoidance of unneeded punishment by the parent and a consistent system of rewards and consequences for the child.
Apart from focusing on specific behaviors, therapy also helps the parents gain understanding as to what is needed to be an effective and fair disciplinarian. Parents should know when to overlook minor behavior problems and which to punish are included in this, as well as conflict resolution and communication skills.
As modern behaviorists believe that only focusing on overt behaviors is somewhat insufficient at times, cognitive behavior therapy is then used. Therapists work with children to assist them in developing a few essential cognitive skills, which include cognitive reconstruction of stressful events to make sure that they do not evoke automatic feelings of anger while thinking of an event. Anger management training may also be taught which includes people to basically manage their feelings of frustration better.
On the other hand, there is also drug therapy. This involves stimulants such as Ritalin, Dexedrine and Cylert which are at times given to children with the disorder in order to minimize impulsivity and hostile and destructive behavior. For this purpose usually the prescribed stimulant used is Ritalin. Lithium, which is usually used to treat Bipolar Disorder, has been prescribed to treat severe aggressive behavior as well. When used appropriately and correctly, it can somewhat minimize affect problems, destructive behavior, unpredictability etc. However, these drugs have side effects which may also adversely affect some people (e.g., nausea, headaches, nervousness are side effects of Ritalin) and thus must be used with caution. The effects can often be temporary and may stop being effective once the drug is no longer used. (Barkoukis, Reiss, & Dombeck, 2008)
Empirical evidence shows that cognitive behavioral therapy is most effective in the case of conduct disorder. As drugs can have numerous side effects and the benefits may not last, this is not a good option.
Future Directions for the Disorder
As society is made more aware of psychological disorders day by day, it is very possible that as people grow more enlightened to possibilities, they may strive to help those in need more. However, as most cases of the disorder come from lower socioeconomic levels, it is essential that this class be made more aware. The DSM IV may come to include this disorder as a part of ADHD as there is a high comorbidity rate.
Barkoukis, A., Reiss, N. S., & Dombeck, M. (2008, February 4). Treatment of Conduct Disorder. Retrieved August 21, 2010, from MentalHealth.net: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=14502&cn=37
Chandler, J. (2002). Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children and Adolescents: Diagnosis and Treatment. Retrieved August 21, 2010, from Attention Deficit Disorder Resources: http://www.addresources.org/article_odd_chandler.php#prognosis2
Davison, G. C., Neale, J. M., & Kring, A. M. (2003). Abnormal Psychology. John Wiley & Sons Inc.
Mauro, M. (2010, January 31). Take All Prisoners. Retrieved August 21, 2010, from Psychology Today: http://www.psychologytoday.com/blog/take-all-prisoners/201001/conduct-disorder
Net Industries. (2010). Conduct Disorder – Cross-cultural Research. Retrieved August 21, 2010, from Family Jrank: http://family.jrank.org/pages/307/Conduct-Disorder-Cross-Cultural-Research.html
Searight, H. R., Rottnek, F., & Abby, S. L. (2001, April 15). Conduct Disorder: Diagnosis and Treatment in Primary Care. Retrieved August 21, 2010, from American Acedemy of Family Physicians: http://www.aafp.org/afp/2001/0415/p1579.html
Tynan, W. D. (2010, January 22). Conduct Disorder. Retrieved August 21, 2010, from eMedicine: http://emedicine.medscape.com/article/918213-overview